Provider Demographics
NPI:1477586055
Name:PROFESIONAL MEDICAL IMAGING SOLUTIONS LLC
Entity Type:Organization
Organization Name:PROFESIONAL MEDICAL IMAGING SOLUTIONS LLC
Other - Org Name:PET IMAGING AT WHITE MARSH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:MULREANSY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-931-4738
Mailing Address - Street 1:9900 FRANKLIN SQUARE DR
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21236-5915
Mailing Address - Country:US
Mailing Address - Phone:410-931-4738
Mailing Address - Fax:410-931-2989
Practice Address - Street 1:9900 FRANKLIN SQUARE DR
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21236-5915
Practice Address - Country:US
Practice Address - Phone:410-931-4738
Practice Address - Fax:410-931-2989
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
No2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDKBB6PEOtherBLUE SHIELD
DCS354OtherBLUE SHIELD
DCS354OtherBLUE SHIELD